Pages Below:
| |
Diabetic Ketoacidosis
- Emergency
- uncontrolled hyperglycaemia
- metabolic acidosis
- greatly raised (> 5mmol/l) ketone levels
Treatment
- replace fluid losses
- replace electrolyte losses
- restore acid-base balance
- restore circulating volume to allow kidney function
- bicarbonate may be justified if pH <7.1
- replace deficient insulin
- low-dose suppresses hepatic gluconeogenesis
- monitor blood glucose closely
- replace energy losses
- change to 5% dextrose when plasma glucose <12mmol/l
- seek underlying cause
Causes
- previously undiagnosed diabetes
- interruption of insulin therapy
- stress of intercurrent illness
- factor in 25%
- insulin should never be stopped
Pathology
- insulin deficiency
- uncontrolled catabolism
- counter-regulatory hormone excess
- dehydration
- hepatic glucose production increases, peripheral glucose uptake falls
- → rising glucose levels
- → osmotic diuresis
- → loss of fluids and electrolytes
- → dehydration
- rapid lipolysis
Clinical Features
- Prostration
- Hyperventilation
- Nausea
- Vomiting
- Abdominal Pain
- Confusion and stupor common
- Dehydration
- Hyperventilation
- Smell of ketones on breath
- low body temperature
Investigations
- blood glucose
- U&Es
- Urinary dipstick
Complications
- hypotension
- coma
- cerebral oedema
- hpyothermia
- late
- stasis pneumonia
- venous thrombosis
- due to therapy
- hypoglycaemia
- hypokalaemia
- pulmonary oedema
- hyperchloraemic acidosis
|